An MMSE score 17-10. Patient requires helps with ADL. Disoriented with time (can't remember date). Can't remember recent memories. May forget family members names. May become emotional. Agitation, paranoia, and delusion may be apparent.

Define severe AD.

An MMSE score of 9-0. Patient loses ability to speak, walk, and eat. May be incontinent.

What drugs can be used in mild AD.

1) Donepezil (Aricept)

2) Galantamine (Razadyne)

3) Rivastigmine (Exelon)

What drugs can be used in moderate AD.

1) Donepezil (Aricept)

2) Galantamine (Razadyne)

3) Rivastigmine (Exelon)

4) Memantine (Namenda)

What drugs can be used in severe AD.

1) Donepezil (Aricept)

2) Memantine (Namenda)

What is the initial dose for donepezil (Aricept)?

5 mg tab q.p.m.

What is the maximum dose for donepezil (Aricept)?

10 mg tab q.p.m.

What is the initial dose for galantamine (Razadyne)?

4 mg tab BID cf or

4 mg oral solution BID cf or

8 mg cap QD cf (ER)

What is the maximum dose for galantamine (Razadyne)?

12 mg tab BID cf or

12 mg oral solution BID cf or

24 mg cap QD cf (ER)

What is the initial dose for rivastigmine (Exelon)?

1.5 mg cap BID cf or

1.5 mg oral solution BID cf or

4.6 mg patch QD cf

What is the maximum dose for rivastigmine (Exelon)?

6 mg cap BID cf or

6 mg oral solution BID cf or

9.5 mg patch QD cf

What is the initial dose of memantine (Namenda)?

5 mg tab QD or

5 mg oral solution QD

What is the maximum dose of memantine (Namenda)?

10 mg tab BID or

10 mg oral solution BID

What are the adverse effects of donepezil (Aricept)?

1) N/V/D

2) muscle cramps

3) urinary incontinence

4) syncope

5) bradycardia

6) fatigue

What are some DI of donepezil (Aricept)?

1) CYP3A4 and 2D6

2) anticholinergic medications

What are some neurotransmitters that are increased with use of galantamine (Razadyne)?

1) glutamate

2) serotonin

What are some side effects associated with galantamine (Razadyne)?

1) N/V/D

2) muscle cramps

3) urinary incontinence

4) syncope

5) bradycardia

6) fatigue

What is the DI for galantamine (Razadyne)?

CYP3A4 and 2D6

What are the adverse effects associated with rivastigmine (Exelon)?

1) N/V

2) anorexia

3) muscle cramps

4) bradycardia

5) syncope

6) fatigue

7) urinary incontinence

What are the adverse effects associated with memantine (Namenda)?

1) HA

2) dizziness

3) sedation

4) agitation

5) constipation

6) hypetension

7) coughing

8) confusion

What are some tools to help measure behavioral symptoms?

1) Neuropsychiatric Inventory (NPI)

a. 144-point scale

b. higher score = severe behavioral problems

2) Behavioral Pathology in Alzheimer's Disease

a. 75 point scale

b. higher score = more behavioral problems

3) Cohen-Mansfield Agitation Inventory

a. 203 point scale

b. higher score = more behavioral problems

What are some drugs used in the treatment of behavioral symptoms?

1) cholinesterase inhibitors

2) atipical antipsychotics

3) valproic acid/carbamezapine

4) antidepressants

5) memantine

What are the atypical antipsychotics used in treatment of behavioral symptoms?

1) risperidone (RisperDAL)

2) olanzapine (ZyPREXA)

What is the initial dose of risperidone (RisperDAL)?

0.25 mg/day

What is the maximum dose of risperidone (RisperDAL)?

2 mg/day

How is the risperidone (RisperDAL) dose titrated up?

It is titrated up in increment of 0.25-0.5 mg/day until 1 mg/day is reached.

What is the dose for olanzapine (Zyprexa)?

5-10 mg/day

What are the side effects associated with the typical antipsychotics?

1) somnolence

2) EPS

3) abnormal gait

4) worsening cognition

5) cerebrovascular events

6) increased risk of death

7) hypotension

What are the antidepressants used in treating behavioral symptoms?

1) citalopram (CeleXA)

2) sertraline (Zoloft)

What two anticonvulsants are used in the treatment of behavioral symptoms?

1) carbamazepine (Carbatrol, Epitol, Equetro, TEGretol)

2) valproic acid (Depacon, Depakene, Stavzor)

What are the two nonbenzodiazepines used in treating behavioral symptoms?